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NPI Code Detail

MEDICARE: BLOOM OF GRACE REHAB LLC

MEDICARE: BLOOM OF GRACE REHAB LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1558861120
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLOOM OF GRACE REHAB LLC
Provider Business Mailing Address
First Line : 441 N BROADWAY ST
Second Line :
City : GREEN SPRINGS
State : OH
Zip : 44836-9689
Country : US
Telephone Number : 419-332-3378
Fax Number : 419-639-2519
Provider Business Practice Location Address
First Line : 22 CLINTON ST
Second Line :
City : BLOOMVILLE
State : OH
Zip : 44818-9399
Country : US
Telephone Number : 419-983-4100
Fax Number : 419-983-4103
Authorized Official
Title or Position : ADMINISTRATOR
Name : KATHY KAY HUNT
Credential :
Telephone Number : 419-332-3378
Provider Enumeration Date : 02/20/2018
Last Update Date : 08/10/2020

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Directions to “BLOOM OF GRACE REHAB LLC ” Practice Location

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